Provider Demographics
NPI:1447208251
Name:ALLEN, DONALD RAY II (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:RAY
Last Name:ALLEN
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4135 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9803
Mailing Address - Country:US
Mailing Address - Phone:330-286-5330
Mailing Address - Fax:330-286-5396
Practice Address - Street 1:1031 W WESTERN RESERVE RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3541
Practice Address - Country:US
Practice Address - Phone:330-965-0900
Practice Address - Fax:330-965-9250
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 271871367500000X
PARN575013367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2625298Medicaid
OH8236623OtherMEDICARE
PAP00999006OtherMEDICARE RAILROAD
PA098543FAMOtherMEDICARE PTAN